Summer Session – 8th July 2020 for 3 hours

Nic Perrim who is a lecturer at Plymouth Marjon University presented a session on the common lower limb pathologies including the causes and presentation of these pathologies.

Reflective Summary 

During this session we discussed pathologies that relate to the hip, groin, knee, leg, calf, ankle and foot. It was interesting to understand at each area what are we most likely to see and what presentation would we expect with them. This will prepare me for third tear when I am conducting my clinical placement assessing, treating and managing clients who are members of the public.

It was important to evaluate the similarities and differences between the most common pathologies at similar areas so we can differentiate between them. For example, some of the most common causes of hip pain are labral injuries where you would expect a history of trauma and femoroacetabular impingement (FAI) which usually present with no trauma.

This session also allowed me to clarify what the Doha Consensus Statement is. It was when researchers came to an agreement on terminology and definition for groin pain that was based on history and physical examination. Also, with the assessment of groin pain we firstly need to rule out if it is hip related groin pain by using special tests etc and then use palpations and resisted muscle testing to identify where the pain is coming from (adductors, iliopsoas, inguinal, pubic).

When we discussed achilles tendinopathy it was vital to be reminded that there are two different sites where the injury can occur therefore, the cause and treatment can differ depending on the site and load can affect the structures differently.

From the presentation I also learnt that there are two broad mechanisms for traumatic knee injuries, decelerating and accelerating. If the athlete was decelerating it is more likely to be a ligament injury, where as if they were accelerating cartilage or meniscal damage could be present. This emphasises that it is important to understand the mechanism so you have a potential pathology in mind therefore can plan treatment and include rehab exercises that relate to the mechanism.

Finally, an interesting topic is diagnosing patellofemoral pain syndrome (PFPS) as it can be challenging, but there are some considerations that may allow us to decide if it is PFPS or something else. Some of the clinical presentations include crepitus or grinding coming from the patellofemoral joint during knee flexion movements, tenderness on patellar facet palpation, small effusion, pain on sitting, rising on sitting, or straightening the knee following sitting.

Areas for further improvement 

If I wanted to work within a specific sport it may be helpful to research the common injuries within the sport so you are aware of how they would present and the management that is necessary to allow for an efficient return to play. Similarly, some pathologies are population specific for example neck of femur stress fractures tend to be seen in runners and endurance athletes. It would be useful for me to research pathologies even further to see if they are more likely in certain people.

Things to Remember:

  1. FAI can cause a labral injury
  2. Osteoarthritis is a whole joint disease
  3. Causes of leg pain is considered to be between the knee and ankle
  4. During a clinical assessment for any leg pain assess neurological and vascular involvement
  5. Refer when the knee is mechanically unstable or locking/clicking/catching/giving away
  6. If you believe a meniscal tear is present the special tests should be performed in a certain order (Mcmurrays, Aspley’s then Thessaly’s) to avoid false positives
  7. In 10% of ligament injuries, fractures are also present so if you suspect ligament damage an X-Ray may be necessary as well
  8. For a ligament injury clinical tests should only be performed once the swelling has decreased else there may be false positives







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